Profitt Chiropractic - (606) 326-0100
Link to Our Philosophy
Link to Services
Link to Conditions & Symptoms
Link to Photos
Link to Forms
Link to External Sites
Link to Contacts
Link to Our Home Page
Forms

You may download the forms below in either Microsoft Word or Adobe Portable Document Format (PDF). You may download the FREE Adobe Acrobat Reader software (used to display the forms inside of a Web page) from Adobe, Inc.

Click the BACK button on your Web browser to return to this Web page after viewing the forms.

When the form is displayed on-screen, print the empty template, fill-out the required fields, and return the forms during your next visit to Profitt Chiropractic.

Form Type Word Format Adobe PDF Format
Accident Injury Report accident.doc accident.pdf
Activities of Daily Living Assessment adl.doc adl.pdf
Case History chistory.doc chistory.pdf
Consent to Treat consent.doc consent.pdf
Policy on Insurance Assignment pia.doc pia.pdf
Treatment of Minor Consent tmc.doc tmc.pdf
     
HIPAA Notice of Privacy Practices practices.doc practices.pdf

---
Link to Our Philosophy Link to Services Link to Conditions & Symptoms Link to Photos
Link to Forms Link to External Sites Link to Contacts Link to Our Home Page

Copyright 2002 Profitt Chiropractic